Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
ISSN: 2319-7706 Volume 4 Number 1 (2015) pp. 380-393
http://www.ijcmas.com
Review Article
The fight against tuberculosis, the loathsome killer
N sir P y n* (Nasser Pouyan)
N sir P y n (Nasser Pouyan), Tehran, 16616-18893, Iran
*Corresponding author
ABSTRACT
Keywords
Tuberculosis,
Streptomycin,
and Isoniazid
Tuberculosis, a serious infections disease is an ancient disgusting killer of humans
which spreads by air droplets and raw milk. Its lesions on the Neolithic man are the
oldest examples of bone tuberculosis. Babylonian described and recognized it as
contagious. Greek, Chinese, and Persian suggested the communicable nature of
tuberculosis. Girolamo Fracastorio and Giovanni Batista Morgagni also described
it. The modern knowledge of this loathsome killer began with Laënnec, and Koch
who identified the tuberculosis bacillus. Pirquet devised the Pirquet test and
Mantou improved his method. Alexander of Trailles recommended sea voyage and
ass s milk as treatment for tuberculosis. Medieval people called it scrofula,
king s touch , and king`s evil. Finsen and Rollier advocated sunlight in the
treatment of TB and established a sanatorium in Swiss Alps. Calmette does not
miss his turn and introduced BCG . Waksman obtained streptomycin and proved
to be useful against TB. Eventually isoniazid joined streptomycin as antituberculosis. Hibbs of New York in 1911, revolutionized the treatment of spinal
tuberculosis by devising a fusion operation.
Introduction
glands of the neck (scrofula) were
established as different manifestation of the
same disease, the tubercle bacillus was
isolated, and tuberculosis of birds and cattle
was recognized.
A disease caused by the bacteria
mycobacterium tuberculosis, is found
throughout the world. Although tuberculosis
has a long history1, medical knowledge of
the disease was not acquired until the
nineteenth century. It was then that lung
tuberculosis, skin tuberculosis (lupus
vulgaris**) and tuberculosis of the lymph
Tuberculosis is usually spread by infected
person air- borne droplets, coughed by
individuals with the active disease and
inhaled by susceptible persons. The bacilli
lodge in the lungs, where conditions favour
their multiplication. At this point, the body
may successfully combat the infection. But
if body resistance is impaired by poor
1
Early medical documents described it as phthisis, or
consumption.
**
Lupus vulgaris, is tuberculous infection of skin and
mucous membranes with formation of nodules which
later may ulcerate.
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
health, or if another onslaught of germs
reaches the lung, the bacteria multiply and
destroy lung tissue. In rare cases the tubercle
bacilli consumed with contaminated food or
milk which has not been pasteurized and the
primary focus of infection is in the digestive
tract1.
An illness that may have been tuberculosis
was recognized by Chinese contagious :
Generally the disease gives rise to high
fever, sweating, asthenia, without localized
pains making all positions difficult and
slowly bringing about consumption and
death, after which the disease is transmitted
to the relations until the whole family has
been wiped out3.
The history and nature
Tuberculosis, the loathsome and disgusting
killer is an ancient disease of humans, and
possibly lesions of tuberculosis discovered
on spine of the Neolithic man, c.7000- 3000
BC, are probably the oldest example of bone
tuberculosis2.
Islamic physicians contributed brilliant
observations that have stood the rest of time.
They described diseases that had hardly
been perceived as such by Greeks. They
understood tuberculosis and pericarditis*
better than their predecessors. Iranian
physician, Avicenna (980-1037), called the
prince of physicians, suggested the
communicable nature of tuberculosis4.
The history of the struggle against
tuberculosis reflects many of the major
developments in medical science from
ancient times to the present. The true nature
of tuberculosis could not be recognized until
Louis Pasteur s germ theory of disease***
Girolamo Fracastorio (c.1478 1553), Italian
physician, physicist, astronomer, and
pathologist, recognized that germs caused
tuberculosis and pondered ways of
destroying them without injuring the tissues
of the patient. For this purpose he
recommended various root preparations and
turpentine, myrrh, and pine.
had supplanted the earlier concepts of
disease as being caused by demons
(Babylonia, Egypt) or by an imbalance of
the humours, or fluids of the body (Greece).
In addition, tuberculosis presented some
special problems because it appeared in
variety of forms, attacking the bones, skin
and viscera as well as the lungs.
Giovanni Battista Morgagni (1682 1771),
Italian physician and anatomist and founder
of modern anatomy and a professor of
Padua, gave an early description of
tuberculosis. Réné Théophile Hyacinthe
Laënnec (1781 1826), French physician and
inventor of the mono aural stethoscope,
described the pathological course of
pulmonary tuberculosis. He recognized early
and later forms of being stages of a single
disease process. Actually the modern
knowledge of tuberculosis began with
Laënnec**, and his description of lung
An ancient Babylonian description of
tuberculosis of the lungs reads: The sick
one coughs frequently, his sputum is thick
and sometimes contains blood, his
respirations give a sound like a flute.
Greek physicians of the Hippocratic School
accurately described pulmonary tuberculosis
and recognized that it was contagious.
***
Louis Pasteur (1822-1895), French chemist and father of
bacteriology and the germ theory, also introduced
pasteurization to destroy pathogenic bacteria, and
developed attenuated strains for vaccination.
*
Pericarditis is inflammation of the membrane surrounding
the heart.
**
Robert Koch (1843-1910), Nobel Prize winner of 1904
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
diseases are considered classics of clinical
observation5.
of X-rays has been more satisfactory in
detecting early cases7. Robert Whytt (1714
1766), physician and foremost British
neurologist of his time described tubercular
meningitis in children, in 17688.
Jean- Antoine Villemin (1827 1892),
French physician and professor in the
Institute at Val-de-Grâce, who made the
fundamental discovery that material taken
from a tuberculous lung and inoculated into
an animal produced the disease6. He indeed
demonstrated experimentally that human
tuberculosis could be transmitted to animals.
Robert Koch (1843 1910), German pioneer
bacteriologist and Nobel Prize winner who
discovered the tubercule bacillus in 1882,
perhaps
his
two
most
influential
contributions were the isolation of the
tubercle bacillus the cause of tuberculosis
and establishment of the essential steps
( Koch s postulate ) required to prove that
an organism is the cause of disease. Koch
believed at first that human tuberculosis and
tuberculosis of cattle were identical disease,
but later decided that they were not and
bovine tuberculosis could not be transmitted
to man. In this he was not accurate.
Clemens Freiherr von Pirquet (1874 1929),
Austrian paediatrician and immunologist
who devised the Pirquet test for diagnosis of
tuberculosis (1907), where old tuberculosis
was applied through a needle scratch on the
skin9. It could be concluded that the
individual had previously had a tuberculous
infection.
In 1910, Charles Mantoux (1877 1947),
improved the Pirquet s method by injecting
the tuberculin between the layers of the skin.
This permitted more accurate control of the
quantity of tuberculin used. (Today a
purified protein derivative of TB bacteria
[ PPD ] has replaced tuberculin.)
The invention of X-ray by Wilhelm Konrad
Roentgen (1845 1923), German physicist
and Nobel laureate enabled physicians to
detect TB in its early stages that treatment
can be more effective.
An English Royal Commission, in 1911,
demonstrated the transmissibility of bovine
tuberculosis. This had important public
health implication, such as the importance of
pasteurizing milk and the necessity of
raising tuberculosis-free herds.
Treatment and Prevention
In treating an infectious disease it is
necessary to strike at the germ that causes it.
Such an approach was obviously impossible
before the true nature of tuberculosis was
discovered and even for many years
afterward treatment was upon rest, diet, and
other
indirect
measures
aimed
at
increasingly the resistance of the body. A
direct assault against TB bacteria deep in the
tissues was made possible by the
introduction of streptomycin*, but it was
Detection of Tuberculosis
Tuberculosis is a chronic, insidious disease
that can establish a firm foothold in the body
long before the victim becomes aware that
he is ill. The discoveries of Pirquet and
Mantoux gave the physician a tool that
enabled him to say: The tissues of this
person have at one time fought a
tuberculosis infection, but left unanswered
the vital question of whether the infection
was conquered or was continuing. The use
*
Streptomycin an antibiotic produced by the actinomycete
soil- fungus Streptomyces griseus, an organic base of
very complicated molecular constitution. Many infections
(some not affected by penicillin) respond to its therapeutic
for his discovery in relation to tuberculosis.
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
them between 1661 and 166512 (3833
patients per year). Slaves on the plantations
suffered mostly from scrofula, as did the
Amerindians of the USA and Canada during
the early twentieth century.
soon discovered that bacteria resistant to the
drugs, PAS (para- aminosalicylic acid), and
isoniazid*, used with streptomycin have
given a brighter hope for controlling the
disease8. Surgery may still be necessary, and
in these cases all or part of lung may be
removed. Less frequently a part of the lung
is permanently or temporarily collapsed.
Treatment
and
Chronological Order
Prevention
Like blacks, Amerindians revealed an
extraordinary susceptibility to the disease
and had little resistance once infected. For
other peoples, tuberculosis began to recede
in the nineteenth century and this dramatic
recession continued into the 20th century.
in
Alexander of Trailles (born 525 AD), a
Greek philosopher and physician noted for
his Libri duodecirn (Twelve Books of
Medicine), recommended sea voyage and
ass s milk as treatment for tuberculosis9, 10.
During the Middle Ages people seem to
have suffered much from the disease most
probably had the glandular form called
scrofula**. In England and France, it was
believed that royalty had the power to cure
the affliction by touching the sufferers, and
from the twelfth until the eighteenth
centuries the king s touch was regularly
used against the condition. Medieval people
indeed called scrofula11 the king s evil or
king s touch, because it was believed that
the disease could be cured by royal touch.
Over 92000 sufferers queued for Charles 11,
King of England (1630 1685), to touch
Niels Ryberg Finsen (1860 1904), Danish
physician and Nobel laureate studied effects
of light in the disease. He showed that blue
and UV light caused inflammation but that
red and infrared*** light were therapeutic in
patient with smallpox, and used UV**** light
to treat lupus vulgaris14. He indeed used
light in the treatment of skin tuberculosis.
Augustus Rollier (1874 1954), a Swiss
physician advocated the use of increasing
doses of sunlight in the treatment of
tuberculosis (1913). He established a
sanatorium in Swiss Alps based on the use
of natural sunlight in the treatment of
tuberculosis. Albert Léon Charles Calmette
(1863 1933), French microbiologist and
follower of Pasteur introduced BCG
(Bacillus Callmette- Guérine*****) a vaccine
of live weakened TB bacteria (1923)15. This
method has been used for mass
immunization in some countries, but has not
been universally accepted for this purpose.
use, particularly tularaemia, influenza meningitis, and
tuberculosis.
*
Pyridine- 4- carboxyhydrazide C6H7N2O used in the
treatment of tuberculosis. Among antibacterial chemical
substances that were developed, isoniazid proved so
effective against the tubercle bacillus that the therapy of
tuberculosis was revolutionized. Streptomycin had been
introduced before, but it required injection and had also
potentially side effects.
**
Scrofula, tuberculosis of the lymph glands of the neck,
characterized by swelling of the neck and, in some cases,
by open wounds which drains a thick greenish yellow pus.
Caused chiefly by the contaminated milk of tuberculosis
cows, scrofula is much less common today than before,
owing to the elimination of tuberculosis in cattle and the
pasteurization of milk. (Encyclopedia International. Vol.16,
p.305.)
***
Infrared therapy, is treatment of disease with
generators producing electric oscillations of a
wavelength between 0.8 and 16 µm.
****
Ultraviolet therapy (UV). Treatment of disease by
ultraviolet rays. The therapeutic rays (300-400 nm) are
generated by two types apparatus: carbon and tungsten arc
lamps and quartz mercury- vapor lamps.
*****
He is best remembered for his work with Camille
Guérine in the development of the first vaccine against
tuberculosis (BCG: Bacillus Calmette- Guérine, 1908).
(Sebastian, Anton. Dates in Medicine. P.209.)
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
In 1944, Selman Abraham Waksman (1888
1973),
Russianborn
American
microbiologist and Nobel Prize winner,
isolated antibacterial substances from soil
actinomycetes. He discovered the anticancer
drug actinomycin, the first effective antituberculosis drug streptomycin (1944), and
neomycin16. He indeed discovered an
antibiotic useful in tuberculosis therapy, and
proved to be use- full against a variety
infections17.
epidemiological, morbidity, and mortality
spectrum. Preventive measures, such as
public health, quarantine, sanitation,
improved nutrition, better living conditions,
personal hygiene, and changing of
behavioural patterns, along with a range of
therapies
and
drugs,
antibiotic,
immunization,
and
increasingly
sophisticated
medical
cares,
and
technologies, have each, in some ways and
at different times, played a significant role in
the secular decline of general mortality
including specific morbidity and mortality
rates of tuberculosis. But although
tuberculosis has been somehow disappeared
from developed world but it still ravages the
developing countries. For instance number
ofcases
of
pulmonary
tuberculosis*
diagnosed by laboratories throughout Iran
for 1986 until 1999 were according the table
1.
Artificial pneumotherapy yielded to
thoracoplasty, an operation to collapse a
lung permanently by removing ribs. Later
tuberculosis surgery involved removal of all
or part of a lung.
In the 1950 s para- aminosalicylic acid and
isoniazid joined streptomycin as antituberculosis drugs. These three agents used
in
different
combinations,
offer
unprecedented control of tuberculosis18.
It must be borne in mind that tuberculosis is
a chronic, insidious disease, and it is
debatable as to whether an absolute cure can
be achieved. Some tubercle bacilli appear to
remain in the lung in a quiescent state even
after the progress of the disease has been
satisfactory halted. Relapses may occur it
poor general health or stress permit the
dormant germs to become reactivated.
Until the twentieth century, most
orthopaedic treatment was mechanical, with
brace, plaster casts, and manipulation, but
some simple operations such as osteotomy
and uncomplicated tendon transplants were
also done. In 1988, Erich Lexer apparently
brilliant success with transplantation of total
knee joints from one person to another. In
1911, Russell Hibbs of New York
revolutionized the treatment of scoliosis and
spinal tuberculosis by devising a fusion
operation, which continues to be improved
upon and modified19.
The highlights
Probably the oldest example of bone
tuberculosis, are lesions of tuberculosis
on the spine of a Neolithic man (c.70003000 BC).
Argument
*
According to the International Classification of Disease
(ICD), tuberculosis includes tuberculosis of respiratory
system; tuberculosis of meninges and central nervous
system; tuberculosis of intestines, peritoneum and
mesenteric glands; tuberculosis of bones and joints; and
other tuberculosis including late effects. (Nasir P y n,
Ministry of Health, List of 150 Causes for Tabulation of
morbidity and mortality, Tehran, 1967, translated in
Persian.)
Mortality rate of tuberculosis in the Western
world has fallen substantially since midnineteenth century. Of course the cause of
this decline remains a subject of debate
amongst medical historians. For, they are
still uncertain of the causes of the changing
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
the layers of the skin.
The invention of X- ray by Wilhelm
Konrad Roentgen (1845 1923),
enabled physicians to detect TB in
its early stages, when treatment can
be more effective.
Alexander of Trailles (c.6th century
AD) recommended sea voyages
and ass s milk as a treatment for
tuberculosis.
In the Middle Ages scrofula, or
tuberculosis of the lymph glands,
was called the king s evil because
it was believed that it could be
cured by the royal touch.
Carlo
Ferlamini
(1847 1918),
pioneered artificial pneumothorax
in the treatment of pulmonary TB.
In this technique air is introduced
into the chest to collapse a lung.
Niels Ryberg Finsen (1860 1904),
used ultraviolet light in the
treatment of skin tuberculosis.
Auguste
Rollier
(1874 1954),
established a sanatorium in the
Swiss Alps based on the use of
natural sunlight in the treatment of
tuberculosis.
Albert Léon Charles Calmette
(1863 1933), and Camille Guérine
(1872 1961), introduced BCG
(Bacillus Calmette Guérine), a
vaccine of live weakened TB
bacteria. This method has been
used for mass immunization in
some countries, but has not been
universally accepted for this
purpose.
In 1944 Selman A. Waksman (1888
1973), discovered streptomycin, an
antibiotic useful in tuberculosis
therapy.
Artificial pneumothorax yielded to
thoracoplasty,an
operation
to
collapse a lung permanently by
removing ribs. Later tuberculosis
Physicians of the Babylonians held the
demon Asakku to be responsible for the
disease, including tuberculosis.
The
Greek
Hippocratic
School
accurately
described
pulmonary
tuberculosis.
Alexander of Trailles recommended sea
voyage and Ass s milk as treatment for
TB.
Tuberculosis was known to Hippocrates
as phthisis.
Girolamo Fracastorio (1483-1553),
Italian pathologist recognized that
germ caused tuberculosis.
Giovanni Battista Morgagni (16821771), a professor at Padua, gave an
early description of tuberculosis of the
kidneys.
Modern Knowledge of tuberculosis
began with René Théophile Hyacinthe
Leönnec (1781-1826), who described the
pathological course of pulmonary
tuberculosis.
Jean Antoine Villemin (1827-1892),
professor in the Institute of Military
Hygiene at Val de Grâce demonstrated
experimentally that human tuberculosis
could be transmitted to animals.
Robert Koch (1843-1910), the father of
modern bacteriology, discovered the
tuberculosis bacterium in 1882.
The
transmissibility
of
bovine
tuberculosis to man was demonstrated
by an English Royal Commission in
1911. This had important public health
implication such as the importance of
pasteurizing milk and the necessity of
raising tuberculosis free herds.
Clemens von Pirquet (1874 1929),
an
Austrian
paediatrician,
developed
a
technique
for
identifying individuals who had
had tuberculosis infection.
In 1910 Charles Mantoux (1877
1947), improved Pirquet s method
by injecting the tuberculin between
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
surgery involved removal of all or
part of lung.
In the 1950, para- aminosalicylic
acid
and
isoniazid
joined
streptomycin as anti tubercular
drugs. These tree agents, used in
different
combinations,
offer
21
unprecedented control of TB .
Tuberculosis was widespread in the
19th and early 20th centuries.
Its only treatment was rest, good
food, lots of sun and fresh air.
The discovery of electricity gave rise
to many diseases including
tuberculosis.
Mortality rate of tuberculosis in
developed countries has fallen
since mid- nineteenth century.
include fever, chills, night
sweats, loss of appetite, and
fatigue. Significant nail clubbing
may also occur.
The World Health Organization
has achieved some success with
improved treatment regiments,
and a small decrease in case
numbers.
The two antibiotics most
commonly used are isoniazid and
rifampicin.
The recommended treatment of
new onset pulmonary TB, as
2010, is six months of a
combination
of
antibiotics
containing rifampicin, isoniazid,
pyrazinamide, and ethambutol
for the first two months, and only
rifampicin and isoniazid for the
last four months as an alternative.
More regarding tuberculosis
Tuberculosis, MTB, TB (tubercle
bacillus), also called phthisis,
phthisis
pulmonalis,and
consumption is an infectious
disease caused by various strain
of mycobacteria, usually by
mycobacterium tuberculosis.
It typically attacks the lungs, but
can also affect other parts of the
body.
Most infections do not have
symptoms, known as latent
tuberculosis.
The classic symptoms of active
tuberculosis are chronic cough
with blood- tinged sputum, fever,
night sweats, and weight loss.
Diagnosis of active TB relies on
radiology as well as microscopic
examination and microbiological
culture of body fluids.
Diagnosis of latent TB relies on
the tuberculin skin test (TST) and
or blood test.
General signs and symptom
Epidemiology point of view
Approximately one- third of
world s population has been
infected with Mycobacterium TB,
with new infection occurring in
about one percent of the population
each year.
Most infections with Mycobacterium
tuberculosis do not cause TB
disease, and 90-95 percent of
infections remain asymptomatic.
About 8.6 million chronic cases were
active, in 2012, and 1.20 1.45
million deaths occurred, most of
these occurring in developing
countries. Of these 1.45 million
deaths, about 0.35 million occur in
those also infected with HIV.
Tuberculosis is the second- most
common cause of death (after those
due to HIV/AIDS).
China has achieved dramatic
progress, with about an 80 percent
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
reduction in its tuberculosis
mortality rate between 1990 and
2010.
About 80 percent of the population
in many Asian and African
countries have the test positive in
tuberculosis, while only 5 10
percent of the US population has
test positive.
In 2007 the country with the highest
estimated
incidence
rate
of
tuberculosis was Swaziland (in
Africa), 12 per 1000 population.
India had an estimated two million
new cases (the largest total
incidence).
In 2010, incidence rate of TB per
100000 population were: Globally:
178; Africa: 332; the Americas: 36;
Eastern
Mediterranean:
137;
Europe: 63; Southeast Asia: 278;
and
Western
Pacific
139.
Tuberculosis is many time more
common among the aboriginal
population, especially in remote
areas. In the United State, the
aboriginal people have a fivefold
greater mortality from tuberculosis,
and racial and ethnic minorities
accounted for 84 percent of all
reported TB cases.
Worldwide, 22 high- burden states
or countries together experience 80
percent of cases as well as 83
percent of deaths.
Tuberculosis is mainly a disease of
older population.
surgeon who wrote on the
paralysis of tuberculosis (Pott
paraplegia).
Lemuel
Hopkin
(1750 1801),
Outstanding American physician,
was an authority on the treatment
of tuberculosis, recommend fresh
air and exercise.
Thomas Beddoes (1760 1808),
English physician founded The
Medical Pneumatic Institution in
Bristol for the treatment of
pulmonary tuberculosis.
Gaspard Laurent Bayle (1774 1816),
French physician who in 1810
described carcinoma of the lung
and the pathological nature of a
tubercule.
Marie Edouard Chassaignac (1805
1879), a Paris surgeon who
described Chassaignac tubercule.
Auguste
Nélaton
(1807 1837),
French surgeon and oncologist
who
described
tuberculosis
osteomylitis.
Lewis Albert Sayre (1820 1900),
American orthopedic surgeon who
invented the Sayre plaster Jacket
for Pott disease.
Charles Fayette Taylor (1827 1899),
American orthopedic surgeon who
developed a brace of Pott
disease22.
More about the major contributions
to fight against tuberculosis
In 1721, E. Barry of Dublin, showed
the infective nature of tuberculosis
through microscopy.
M. Bourru of Paris, made the first
suggestion
of
artificial
penumothorax as treatment of
tuberculosis, in 1770.
Wilhelm
Roser
(1817 1888),
German professor of surgery at
Studies and Researches
Robert
Whytt
(1714 1766),
physician and foremost British
neurologist of his time discovered
spinal shock and tubercular
meningitis in children.
Percivall Pott (1714 1788), British
387
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Marburg who defined surface
marking from the anterior superior
iliac spine to the ischial tubercles
(Roser line).
Ernst Victor von Leyden (1832
1910), German physician established
sanatoria
for
treatment
of
tuberculosis.
Johann Nepomak Rust, German
surgeon who described tuberculous
spondylitis of the cervical vertebrae
(rust disease); in 1834.
Theodor Albrecht Edwin Klebs (b
1834), a German bacteriologist who
pointed out the tuberculous cavities
in the lungs as a source of intestinal
tuberculosis (1873). He also
demonstrated the peculiar property
of acid fastness of the tuberculous
bacilli (1896).
Fritz Waldemar Rasmussen (born
1834), Danish physician who
described a branch of the pulmonary
artery affected by tuberculosis
(Rusmussen aneurysm).
Sir Robert William Philip (1857
1939), Scottish pioneer in the study
and control of tuberculosis, who
established the first tuberculosis
dispensary in the world in
Edinburgh, in 1888.
Sigard Adolphus Knopf (1857
1940), New York and pioneer in the
treatment of tuberculosis, promoted
the Knopf method of breathing using
diaphragmatic muscles rather than
intercostal muscles in apical lobe
tuberculosis.
Theobald
Smith
(1859 1934),
American pioneer bacteriologist and
professor of microbiology at
Harvard.
Henry Tirboulet (1864), French
physician who devised a fecal test
for intestinal tuberculosis, which is
now obsolete.
Mark Armand Ruiffer (1859), a
pioneer in paleopathology who
studied
conditions
such
as
tuberculosis, arteriosclerosis, and
gallstones.
In 1868, Auguste Chauveau of Paris
was the first to demonstrate
experimentally in animals that
swallowing tubercular matter led to
ulceration in the intestines (intestinal
tuberculosis).
Sir Hugh William Bell Cairns
(1896 1952),
an
Australian
neurologist. He, in1949 gave a clear
description
of
hydrocephalus
following obstruction of the flow of
cerebrospinal fluid secondary to
tuberculosis meningitis.
Sir Hugh William Bell Cairns
(1896 1952), Australian neurologist
who gave a clear description of
hydrocephalus following obstruction
of the flow of cerebrospinal fluid
secondary to tuberculosis meningitis
in 1949.
In 1898, made the clear distinction
between bovine and human tubercle
bacilli.
Walch McDermott (1909 1981),
American physician and founder of
the institute of Medicine of the
National Academy of Science who
introduced
pyrazinamide
in
combination with isoniazid as firstline treatment for tuberculosis.
The great victims of tuberculosis
With urban and industrial development since
sixteenth century onwards, the virulent
tuberculosis become dominant in most
countries, and many places 500 or more of
every 100000 people died from it. Many of
the victims of tuberculosis were very great
men including:
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Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Sim n Bol var (1783 1830), called The
Liberator South American beader in
movement for independence.
population. As population increased,
hospitals became more crowded, and it was
not possible to keep them hygienic. Patients
would share beds during an outbreak,
increasing the danger of infection, and
diseases such as tuberculosis. The discovery
of Pirquet and Mantoux gave physicians a
tool of detection of tuberculosis. Also the
use of X- rays has been more satisfactory in
detecting early cases.
Frédéric Chopin (1810 1849), outstanding
Polish composer.
Robert Koch (1843 1910), German pioneer
bacteriologist and Noble Prize winner who
discovered tuberculosis bacillus.
Anton Pavlovich Chekhov (1860 1904),
Rassian dramatist and fiction writer,
although received a medical degree in
medicine (1884) but devoted his life to
writing and eventually became a great
victim of tuberculosis.
The impacts of the newer anti- TB drugs,
para- aminosalicylic acid and isoniazid, used
with streptomycin have given a brighter
hope for controlling and eradicating
tuberculosis. Specific mortality rate of
tuberculosis in developed countries has
fallen since mid-19th century. Preventive
measures, such as, public and personal
health, quarantine, sanitation, pasteurization
of milk, improved nutrition, infant and
mother care and welfare, better living
conditions, changing behavioural pattern,
along with increasingly sophisticated
medical care and immunization and
technology, have each, in some ways and at
different times played a significant role in
the decline of morbidity and mortality rates
of tuberculosis.
Conclusion and Impact
Tuberculosis, an ancient disease of humans,
and possibly evolved with them, in
nineteenth century killed millions and in
some places it affected all of the population.
Its true nature could not be understood until
the introduction of germ theory of disease
by Louis Pasteur (1822 1895). Tuberculosis
itself presented some problems because it
appeared a variety of forms attacking the
skin, bones, viscera as well as lungs.
Another leading problem was the growth of
Table.1 The morbidity rate of tuberculosis
Year
1986
1991
1995
1996
1997
1998
1999
Number of
Cases
diagnosed by
laboratories
7004
11090
11631
9578
9207
8410
8565
Population
49000000
56000000
58800000
60000000
61200000
62400000
63600000
389
Morbidity rate
per 100,000 of
population
14.3
19.8
19.2
16.0
15.0
13.5
13.5
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Fig.1 Lesions of tuberculosis on the spine of a Neolithic man (the oldest example of bone
tuberculosis)
Fig.2 Tuberculosis decay has been found in the spine of Egyptian mummies (From: British
museum)
Fig.3 Réné T.H.Laënnec (1781-1826), died of tuberculosis, in 1826 (Drawn and lithographed
by himself)
390
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Fig.4 Microscopic slide showing tubercule bacillus
Fig.5 Robert Koch (1843-1910), Nobel Prize winner of 1904 for his discovery in relation to
tuberculosis
391
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Fig.6 Right: Mummy of priest of Amen (c. 1000 BC), with profile view showing protrusion
of spine common to Pott s disease (tuberculosis of spine). Left: Frontal the same mummy
showing huge psoas abscess into which tubercular lesion drained
Fig.7 Gold touch pieces.Some kings and ruler were believed to have healing powers, curing
their subject by touch with gifts. These gold touch pieces from the reign of James I of
England (1603-1625), were thought to cure a wide spread, disfiguring form of tuberculosis
called Scrofula13
Fig.8 In Middle Ages various swelling and conditions were well known, notably scrofula.
Scrofulous sores were treated with cleansing and ointments as shown in these drawing from a
13th- century translation in Norman French of Roger of Parama s surgical treatise chirurgia
392
Int.J.Curr.Microbiol.App.Sci (2015) 4(1): 380-393
Fig.9 A tuberculosis sanatorium built at paimio, Finlan, to design by A.Aalto, 1929- 1933
Porter, Roy. The Cambridge Illustrated
History of Medicine. P.977.
Encyclopedia International. Vol. 19,
p.178.
Lyons, Albert S. Medicine, an Illustrated
History. P.590.
Encyclopedia International. Vol.11, p.495.
Lyons, Albert S. Medicine, an Illustrated
History. P.599.
Iran Statistical Year Book, Statistical
Center of Iran, 1999, Serial
No.3420, Tehran, 2001, p.704.
Ibid. Vol.11, pp.494 and 495.
En. Wikipedia.Org/Wiki/Tuberculosis.
Consult. Freedberg and , Irwin M. Fitz
Patricks Dermatology In General.
USA, 1999; Mackey, H.O.A
Handbook of Diseases of The Skin.
London, Macmillan & Co. LTD,
1964; Islah Arabani, Ibrahim, Kitab
Gilan. Vol.3, pp.556-568 (by Nasser
Pouyan); Pouyan, Nasser. A
Research on the Activities of
Massih- Danashvari/ Respiratory
Diseases Hospital ,Tehran,1987.
References
Encyclopedia International. Vol. 8,
Grolier, New York 1975, p.253.
Lyons, Albert S. Medicine, an Illustrated
History. Abradale Press, New York,
1987, p.21.
Ibid.P.139.
Ibid.P.298.
Encyclopedia International. Vol.10, p.317.
Lee, S.H.J. The Medical Millennium. The
Parthenon Publishing Group, New
York, London, 2000, p.104.
Porter, Roy. The Cambridge Illustrated
History of Medicine. Cambridge
University Press, 1996, p.375.
Encyclopedia International. Vol.11, p.494.
Sebastian, Anton. Dates in Medicine. The
Parthenon Publishing Group, New
York, London, 2000, p.239.
Ibid.P.295.
Porter, Roy. The Cambridge Illustrated
History of Medicine. P.37.
Parker, Steven. Eyewitness Medicine.
Dorling Kindersley, New York,
London p.36.
Ibid.P.23.
Lee, S.H.J. The Medical Millennium.
P.36.
393